Allergic Bronchopulmonary Aspergillosis

Agarwal, Ritesh; Muthu, Valliappan; Sehgal, Inderpaul Singh; Dhooria, Sahajal; Prasad, Kuruswamy Thurai; Aggarwal, Ashutosh N.

doi:10.1016/j.ccm.2021.12.002

Cited by 49 publications

(56 citation statements)

References 221 publications

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“…Peripheral blood mononuclear cells (PBMCs) of patients were isolated and stored in liquid nitrogen. Thawed PBMCs of ABPA patients and A.f (+) asthma patients were incubated with 25 μg/ml A.f allergen extracts and 100 ng/ml PMA (phorbol-12myristate 13-acetate, MCE, China) for 6 h. PBMCs of house dust mite (HDM)-positive group were incubated with 25 μg/ml HDM and 100 ng/ml PMA also for 6 h as control, and then, the harvested cells were prepared at a concentration of 1×10 6 in 100 μl flow cytometry (FACS) staining buffer and were stained with Live/Dead Fixable Read cell stain kit (Invitrogen, USA), antihuman CD3, CD4, CD183 (CXCR3), CD294 (CRTH2), CD25, CD127, IL-4, IL-13, and IFN-g antibodies (Biolegend, USA), and CD279 (PD-1), IL-10, and CD185 (CXCR5) (BD Biosciences, USA). T subsets were gated by Th1 (CD3 + CD4 + CXCR3 + ), Th2 (CD3 + CD4 + CRTH2 + ), Tfh (CD3 + CD4 + CXCR5 + PD-1 + ), and Treg (CD3 + CD4 + CD25 + CD127 low/− ) (12,13).…”

Section: Cell Staining and Flow Cytometric Analysismentioning

confidence: 99%

“…Allergic bronchopulmonary aspergillosis (ABPA) is a chronic inflammation triggered by repeated exposure to A.f , which has colonized for a long time in the airway ( 5 ). The clinical manifestations include chronic asthma or bronchiectasis and recurrent wandering pulmonary shadows or mucus blockage in lung images ( 6 ). While ABPA was mostly found in patients with bronchial asthma or cystic fibrosis in Western countries, it was more common in patients with asthma and bronchiectasis in China ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

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Clinical and immunological characteristics of Aspergillus fumigatus-sensitized asthma and allergic bronchopulmonary aspergillosis

Chen

Zhang

et al. 2022

Front. Immunol.

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BackgroundAspergillus fumigatus (A.f) is a common airborne allergen that contributes to allergic asthma. In some patients, A.f can colonize in the airway and lead to allergic bronchopulmonary aspergillosis (ABPA). However, our understanding of the pathogenesis of A.f-sensitized asthma and ABPA remains inadequate.ObjectiveWe aimed to investigate the clinical and immunological characteristics of A.f-sensitized asthma and ABPA.MethodsA total of 64 ABPA and 57 A.f-sensitized asthma patients were enrolled in the study, and 33 non-A.f-sensitized asthma patients served as the control group. The clinical and immunological parameters included lung function, fractional exhaled nitric oxide (FeNO), induced sputum and blood cell analysis, specific IgE/IgG/IgA of A.f and its components, cytokines (IL-33, IL-25, and TSLP) and CD4+T cell subsets.ResultsThe eosinophils in blood, induced sputum, and FeNO were significantly higher in ABPA patients compared to that in A.f-sensitized patients. The combination of FeNO and eosinophils (EO) parameters presented good diagnostic efficiency in differentiating A.f (+) asthma from ABPA, with a sensitivity of 80% and a specificity of 100%. Specific IgE, IgG, and IgA against A.f also increased in ABPA patients. However, serum IL-25, IL-33, and TSLP showed no significant differences between the two groups. Cell analysis showed an increase in IFN-γ+Th1 cells in the ABPA patients. FlowSOM analysis further confirmed that the frequency of CD3+CD4+PD-1+CD127+IFN-γ+T cells was higher in ABPA patients.ConclusionOur findings suggest the distinct humoral and cell immunological responses in A.f-sensitized asthma and ABPA patients. ABPA patients have more severe eosinophilic inflammation and enhanced Th1 responses compared with A.f-sensitized asthma patients.

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Section: Cell Staining and Flow Cytometric Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical and immunological characteristics of Aspergillus fumigatus-sensitized asthma and allergic bronchopulmonary aspergillosis

Chen

Zhang

et al. 2022

Front. Immunol.

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“…1,2 ABPA is currently diagnosed using a composite of clinical, radiological, and serological findings. 3 The detection of A. fumigatus-specific IgG is crucial in diagnosing ABPA and helps differentiate ABPA from asthma with fungal sensitization. 4 The IgG antibodies against A. fumigatus were initially measured using the immunoprecipitation methods (agar gel double diffusion or counterimmunoelectrophoresis).…”

Section: Introductionmentioning

confidence: 99%

“…Allergic bronchopulmonary aspergillosis (ABPA) is a lung disorder caused by immune responses against Aspergillus fumigatus colonising the airways of patients with asthma and cystic fibrosis 1,2 . ABPA is currently diagnosed using a composite of clinical, radiological, and serological findings 3 . The detection of A. fumigatus ‐specific IgG is crucial in diagnosing ABPA and helps differentiate ABPA from asthma with fungal sensitization 4 …”

Section: Introductionmentioning

confidence: 99%

Comparative diagnostic accuracy of immunoprecipitation versus immunoassay methods for detecting Aspergillus fumigatus‐specific IgG in allergic bronchopulmonary aspergillosis: A systematic review and meta‐analysis

Sehgal

Dhooria

Prasad

et al. 2022

Mycoses

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Background The diagnostic accuracy of immunoassays versus immunoprecipitation methods for detecting A.fumigatus‐specific IgG in patients with allergic bronchopulmonary aspergillosis (ABPA) complicating asthma remains unclear. Methods We performed a systematic review to identify studies describing both the methods in the same ABPA subjects. We assessed study quality using the QUADAS‐2 tool. We derived the relative sensitivity and specificity using the HSROC meta‐regression model. We calculated the number‐needed‐to‐test using an immunoassay to detect one additional positive test in ABPA. Results Our search yielded 20 studies (796 ABPA and 929 controls). The studies had a high risk of bias. The summary estimates for sensitivity and specificity of immunoprecipitation methods were 68.6% (95% CI, 48.4–83.5) and 93.8% (95% CI, 83.6–97.8), respectively, while for immunoassays they were 85.2% (95% CI, 73.3–92.3) and 84.6% (95% CI, 76.0–90.5), respectively. The relative sensitivity and specificity of immunoassays compared to immunoprecipitation tests were 1.29 (95% CI, 1.1–1.6) and 0.91 (95% CI, 0.85–0.97), respectively. The automated immunoassays (1.77; 95% CI, 1.1–2.8) had better relative sensitivity than the manual (1.1; 95% CI, 1.02–1.18) assays compared to immunoprecipitation. The relative specificity of manual immunoassays (0.95; 95% CI, 0.91–0.99) was significantly lower, while that of automated (0.88; 95% CI, 0.77–1.0) assays was lower but not statistically different. One additional positive result was detected for every six (95% CI, 5–7) tests performed with immunoassay (versus immunoprecipitation). Conclusion Compared to immunoprecipiation methods, automated immunoassays have higher sensitivity and similar specificity, manual immunoassays have higher sensitivity and lower specificity, while automated immunoassays have higher sensitivity and similar specificity for detecting A.fumigatus‐IgG in patients with ABPA. [http://www.crd.york.ac.uk/prospero/display_record.php?RecordID%3D309864].

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“…Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder caused by complex hypersensitivity reactions targeted against Aspergillus fumigatus colonizing the airways of patients with asthma (and cystic fibrosis) (Agarwal et al, 2022). ABPA patients typically present with difficult-to-control asthma, recurrent pulmonary opacities, and bronchiectasis (Kosmidis and Denning, 2015).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Simpler Criteria for Diagnosing Allergic Bronchopulmonary Aspergillosis Complicating Asthma

Agarwal

Saxena

Muthu

et al. 2022

Front. Cell. Infect. Microbiol.

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BackgroundThe modified International Society for Human and Animal Mycology (ISHAM) allergic bronchopulmonary aspergillosis (ABPA) working group (AWG) criteria lists up to five components for diagnosing ABPA in asthmatics. Whether eliminating specific components of the existing criteria would have the same diagnostic utility as the original remains unknown.ObjectiveTo evaluate the performance of several simplified criteria for diagnosing ABPA.MethodsWe compared the performance of seven new criteria (after excluding or modifying one or more of the components of the ISHAM-AWG criteria) with the modified ISHAM-AWG criteria in asthmatic subjects using latent class analysis (LCA). We also tested the performance of the newer criteria using accuracy measures against a multidisciplinary team (MDT) diagnosis of ABPA. We considered the diagnostic accuracy of the newer criteria to be acceptable if the correct classification and false-negative rates were >95% and <5%, respectively, on an MDT evaluation.ResultsWe analyzed data from 543 asthmatic subjects (58.8% women; mean age, 36.8 years). Using LCA, the sensitivity of the A.fumigatus-specific IgE-based criteria ranged from 92-99%, while the specificity varied between 92% and 100%. The MDT diagnosed ABPA in 106 (19.5%) subjects. Using MDT as the reference standard, the correct classification and false-negative rates were >95% for three of the seven and <5% for four of the seven newer criteria.ConclusionsWe found several of the newly developed criteria to perform, like the modified ISHAM-AWG criteria, for diagnosing ABPA complicating asthma. A prospective study in current clinical algorithms is required for validating our observations.

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Allergic Bronchopulmonary Aspergillosis

Cited by 49 publications

References 221 publications

Clinical and immunological characteristics of Aspergillus fumigatus-sensitized asthma and allergic bronchopulmonary aspergillosis

Clinical and immunological characteristics of Aspergillus fumigatus-sensitized asthma and allergic bronchopulmonary aspergillosis

Comparative diagnostic accuracy of immunoprecipitation versus immunoassay methods for detecting Aspergillus fumigatus‐specific IgG in allergic bronchopulmonary aspergillosis: A systematic review and meta‐analysis

Evaluation of Simpler Criteria for Diagnosing Allergic Bronchopulmonary Aspergillosis Complicating Asthma

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